Healthcare Provider Details

I. General information

NPI: 1487198511
Provider Name (Legal Business Name): WESTSIDE PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WESTFALL RD BLUIDING C SUITE 130
ROCHESTER NY
14618-2638
US

IV. Provider business mailing address

919 WESTFALL RD BLUIDING C SUITE 130
ROCHESTER NY
14618-2638
US

V. Phone/Fax

Practice location:
  • Phone: 585-506-9790
  • Fax: 585-697-0116
Mailing address:
  • Phone: 585-506-9790
  • Fax: 585-697-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL ERIC TELLEM
Title or Position: PARTNER
Credential: DPM
Phone: 585-225-9452